Quis custodiet ipsos custodes?

Professor Joan Higgins, Chair of the Federal Working Group on Complementary Therapies, is in charge of setting up the Natural Healthcare Council (Ofquack). From April, this will be a voluntary self-regulated body that will be tasked with protecting the public from the dangers of alternative medicine. The Professor wrote to the Guardian today to complain about Polly Toynbee’s straight talking article,

I am sorry that Polly Toynbee feels that the creation of a new regulator “gives non-science a new authority”. As a lay person, I am certainly not able to judge the scientific validity of these therapies and this is not what my working group (to which she refers) was set up to do. I would ask her to consider an alternative scenario. Complementary therapists have been in practice for many years. There is public demand for their services and there is no move to stop therapists offering their services to sometimes quite vulnerable people. If complementary therapy is not to be banned, is it not, therefore, wise to regulate it and offer the public some measure of protection and a body to whom to complain if things go wrong?

The problem is that the Professor is not the only person who is ‘certainly not able to judge the scientific validity of these therapies’. No one involved appears to want to tackle the inconvenient problem that most alternative therapies do not work. But without acknowledging this, how can a regulator protect the public? If a homeopath advises a mother that sugar pills can be used to ‘treat’ their child’s asthma will the homeopath be in breach of any code? Their training as a homeopath may be thorough, their professional conduct may be solid – but their medical advice is appalling. Who is going to set the standards of what is good practice? Who is going to guard the standards that Ofquack guard?

Professor David Colquhoun is tackling this problem and is using the Freedom of Information Act to get to the bottom of this. His most recent blog post on the (Un)-Natural Healthcare Council is hilarious.

Professor Colquhoun believes that the whole regulatory infrastructure is unnecessary and that a strengthening of existing legislation would suffice. I would tend to agree with him and I have commented on these pages about the shortcomings of Trading Standards and the Advertising Standards Authority in dealing with quackery.

However, there may be other options. The Financial Services Authority has created huge upheavals in banking and lending over the last decade. In short, they have forced anyone offering financial advice to conform to standards of disclosure and product information. Anyone offering financial services must make an initial disclosure to their clients outlining the nature of the service they are offering, the method by which they will receive payments and commissions, how the service provider is regulated and how to make a complaint. When recommending a financial product, the advisor must present a Key Facts Illustration (KFI) document that outlines in standard terms the features of the products, the risk associated with the product, and full costs.

I see merit in exploring this idea for alternative medicine. In fact, this would bring CAM practitioners more in line with their hospital colleagues – it is giving their clients the information required to make informed consent.

In the USA, California have already introduced a similar scheme: California Senate Bill SB577 . The reason for introducing this bill though was rather different. Before that, people like Homeopath Dana Ullman got arrested for practicing medicine without a license. The Bill allowed people to practice CAM but within a legally controlled framework. This is not the same as self-regulation. This is external regulation.

There are some pretty sound elements to it, like making it illegal to:

recommend the discontinuance of legend drugs or controlled substances prescribed by an appropriately licensed practitioner.

…shall disclose in the advertisement that he or she is not licensed by the state as a healing arts practitioner.

Importantly, they have to perform a disclosure:

(1) Disclose to the client in a written statement using plain language the following information:

(A) That he or she is not a licensed physician.(B) That the treatment is alternative or complementary to healing arts services licensed by the state.(C) That the services to be provided are not licensed by the state.(D) The nature of the services to be provided.(E) The theory of treatment upon which the services are based.(F) His or her educational, training, experience, and other qualifications regarding the services to be provided.

(2) Obtain a written acknowledgement from the client stating that he or shehas been provided with the information described in paragraph

I would go further than that list. For example, any attempt to undermine this disclosure or denigrate or undermine a person’s GP or their advice would be an offense.

As I believe that the biggest threat to homeopathy is people finding out what it is. I would suggest that the CAM Key Facts Illustration contained two extra elements: the theory behind the therapy and whether it is supported by science and the evidence base for effectiveness of the treatment. Obviously, such statements could not come from the practitioner themselves. We are trying to protect people from their non-medically qualified practitioners delusions. The MHRA could possible provide such statements for each therapy in the same way that the Financial Services Authority provide sample paragraphs for inclusion in mortgage documents.

I see the challenges here are with how to enforce this sort of regulation. What is to be avoided is any sort of licensing as this implies government approval. Can we find a way to carry out licensing in a way that does not imply endorsement? For example, Oxford City Council licenses a sex shop on the Cowley Road, apparently. (Ben Goldare tells me there is one there.) This does not imply that Oxford approves of any the appliances found therein. Do we need licensing? Trading Standards does not need a list of licensed plumbers to enforce various regulations. Who would pay for the extra demands on local councils? Maybe Sue Blackmore’s proposals to Tax the homeopaths would be required in parallel.

8 Comments on Quis custodiet ipsos custodes?

its clearly ‘quackers’ to have “a lay person…not able to judge the scientific validity of these therapies” (as Prof Higgins says about herself) to head up an organisation that the public will consider, er, will ‘judge the scientific validity of these therapies’.More importantly, to judge the questionable actions of a therapist against expected practice based on the “scientific validity” of their chosen woo subject.

There again, perhaps this should be a salutatory warning to the public about just how relaxed the alt.health industry and its self-regulatory (or should that be self-congratulatory?) bodies are when comes to exploiting the vulnerable against a backdrop of ‘pic’n’mix’ practices designed to ensure the maximum placebo response for optimum income generation.

This is worse than letting the lunatics run the asylum – at least they know the layout of the place. Indeed, it’s akin to pill-pushing vitamin entrepreneurs assuming control of your childs education.

This is all good stuff (and David Colquhoun’s blog is as funny and as apt as ever), but I have a nagging worry about one of your recommended strictures, namely your idea that ‘any attempt to undermine this disclosure or denigrate or undermine a person’s GP or their advice would be an offense.’

You are straying into some rather difficult territory, as a) there are more than a few medical practitioners working at distinctly sub-optimal levels of competence, and b) there are legitimate concerns about the validity of some of the current medical / industrial norms. Ask any research cardiologist about statins, for example.

I believe that your suggestion would stifle (criminalise) an area of debate which, while not as well controlled as occurs in the scientific literature or among the scientific community at large, is still potentially valuable in that it can eventually lead to more formal investigations.

Criminalising the expression of views that you disagree with is not, I would submit, a politically healthy direction to go down. Let’s not create a medical version of Sharia.

Maybe we could be more specific, and more case-sensitive. If you were to make it an offence to deliberately mis-represent science – medical or otherwise – with the aim of profiting thereby, that, I think, would be the basis of a more reasonable form of legal control.

I wrote a long post echoing much of what quacknet said but it got lost in the ether. You can’t legislate for thoughts and opinion. My teenage libertarian instincts still kick in now and again. The real issue is not the silencing of homeopaths but making them accountable for their actions.

Good points quacknet and gimpy. I am not trying to limit freedom of speech. If a homeopath wants to bad mouth ‘allopaths’ on a bulletin board then fine. But in the context of a regulated activity then I think it is fair to state what sort of behaviours are acceptable. We are talking about a fee-earning consulatation here.

The FSA example is a good one. A financial advisor cannot make a initial disclosure to say that they are acting in the capacity as ‘execution only’ and then offer advice on what mortgage to buy. This is not limiting their freedom of speech, but ensuring their actions are transparent and consistent. I see no problem with insisting that alternative medicine practitioners act consistently with their disclosures. The alternative might be top make non-medically qualified alternative medicine practices illegal – as say, NMQP Homeopaths are in France. Is that a curtailment of freedom of speech?

The alternative might be top make non-medically qualified alternative medicine practices illegal – as say, NMQP Homeopaths are in France. Is that a curtailment of freedom of speech?On the face of it that seems an entirely reasonably suggestion. However, I suspect the homeopaths would argue “why single out homeopathy for special treatment?”. What differentiates homeopathy from the acupuncturists, the chiropracters, reiki healers, naturopaths, etc? Why not insist that all alt-therapies can only be carried out by medically qualified practitioners? Politically untenable perhaps but possibly the only logical solution. But I have to confess doing so would still ruffle my libertarian feathers.

No need to be too libertarian, gimpy. By joining an organisation like the Society of Homeopaths, you are ostensibly surrendering some of your freedoms to practice in return for an authoritative endorsement of your ‘skills’. Homeopaths get a pretty good deal though because SoH do not appear to enforce any of their restrictions on practice.

External regulation may be the only answer as homeopaths, especially, are systematically incompetent. Their paricular beliefs about science, evidence and medicine mean they are incapable of apprasing their own competence and practice and see themselves as being a complete alternative to conventional medicine. Other disciplines do not hold this dual strand of complete delusion and utter arrogance to the same degree, from what I see.

An excellent point LCN but I suspect your argument may be difficult to define legislatively.

I think it is a terrible shame that no homeopaths are responding to your posts. There is no question that ‘something must be done’ but if that something is legislative in nature, and the arguments for this are compelling, then in the interests of fairness homeopaths must be engaged. If they refuse to take part in this debate then they will be disenfranchised by default. In an open democracy that is a appalling but easily avoidable fate.